Clinical Outcomes of Duodenal Lesions in Patients with Familial Adenomatous Polyposis

Abstract

[Aims] Duodenal adenocarcinoma is the leading cause of death in FAP patients besides colorectal cancers. The aims of this study were to describe the natural history of duodenal lesions with FAP patients in our hospital. [Patients and Methods] This study involved 80 patients with FAP being diagnosed by colonoscopy and upper gastrointestinal endoscopy between 1997 and 2012 at the National Cancer Center Hospital, Tokyo, Japan. We reported the clinicopathological features and management and the Spigelman classification of the duodenal lesions. [Results] Forty-one (51%) of the 80 FAP patients had duodenal adenomas (extra-ampullary) and five (6%) had duodenal adenocarcinoma. Among 36 patients with duodenal adenomas who were followed up, 4 (11%) patients were treated with endoscopic resection. Three (8%) of 36 lesions developed duodenal adenocarcinoma. In this study, there were no patients who died of duodenal adenocarcinoma. Duodenal adenocarcinoma was detected in four (50%) of eight patients with stage IV on Spigelman classification during the study. [Conclusions] The death from duodenum lesions was not observed during the study. We consider the careful follow-up examination using endoscopy and endoscopic resection is useful to prevent the tumor progression of duodenal lesions. In addition, the Spigelman classification might be beneficial for the risk assessment of duodenal malignant potential.